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CHAIN OF CUSTA RECORD <br /> Advancedz <br /> Date ZS Page Z- of 2 ' <br /> -- GeoEnvironmental, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client WQ�f d� ���� Project Manager ' Tests Required <br /> .IV W <br /> Phoney umber <br /> (90 7) 4 7.- <br /> Sam Pers: ignature) Invoice: <br /> AGE <br /> Project Name � UK co Client E]� <br /> Sample Type <br /> Sample Location Date Time Water Solid No. of Notes <br /> Number Description comp. Grab. Air Conts. <br /> 5r,1 05-r 47 V64s <br /> fi ( nalur y: �gnature � ,¢ ��� Sr "'w'•��D �—� �f— `� I Ds1elTime <br /> c1 / f ate/Time <br /> (Signature) <br /> by: {Signator r—'� <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> DatelTime <br /> Date/Time Received for Laboratory by: Datertime <br /> Dispatched by: (Signature) <br /> Laboratory Name <br /> Method of Shipment: Cf ^ ,, l <br /> L Ih11 !�5'Y�J/11V1 ! hereby authorize the pleir'fTolrVt ancf the above Indicated work. <br /> Special Instructions: <br />